Preconception Care and Prenatal Care

NICHD seeks to increase awareness about the importance of preconception care and prenatal care to promote a healthy pregnancy and the best outcomes for mothers and babies. Areas of investigation include:

Evaluating maternal health during pregnancy. Studies supported by the Pregnancy and Perinatology Branch (PPB), within the NICHD's DER, focus on the pathogenesis of symptomatic and asymptomatic maternal infections, the state of women's mental health during pregnancy, and the etiology and pathophysiology of sleep-disordered breathing in pregnancy.

Evaluating techniques to develop and refine prenatal screenings. The DER's Intellectual and Developmental Disabilities Branch supports studies leading to the development and refinement of screening methods for conditions leading to intellectual and developmental disabilities.

Investigating the role of nutrition during pregnancy. Researchers supported by the NICHD and the National Institute of Neurological Disorders and Stroke have reported new findings related to the interaction between folic acid supplementation, an important tool in prenatal care, and genetic pathways that could inform strategies to optimize the prevention of neural tube defects (NTDs) such as spina bifida (PMID: 20843827).

In addition, researchers supported by the Pediatric Growth and Nutrition Branch of the DER are studying iron-deficiency anemia in newborns to determine if identifying and treating iron deficiency in pregnancy can reduce this prevalent problem.

Establishing a national standard for fetal growth. A current trial led by the NICHD's DIPHR focuses on establishing a standard for both singleton and multiple pregnancies. Researchers will measure fetal growth via ultrasound, working with 2,400 women from their first trimester through delivery.

Studying medication use during pregnancy. The Effects of Aspirin in Gestation and Reproduction (EAGeR) Study, supported by the DIPHR, is examining the therapeutic value of low-dose aspirin in prenatal care. The research will analyze the effects of low-dose aspirin in combination with the intake of folic acid, compared with folic acid alone, on the incidence of miscarriage and other outcomes.

Evaluating effects of drinking alcohol and smoking tobacco on pregnancy outcomes. The Pregnancy and Perinatology Branch in the NICHD DER is studying alcohol use during pregnancy and its effects on infants. Other studies through the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network are investigating the impact of alcohol use and tobacco smoking, both before and during pregnancy, on risk for Sudden Infant Death Syndrome (SIDS).

In addition, an animal study by researchers in the Unit on Perinatal and Developmental Neurobiology, within the DIR, found that neuroprotective peptides may reduce changes in the immune system that are caused by prenatal exposure to alcohol. Fetal alcohol syndrome (FAS) and related disorders occur in children of mothers who consumed alcohol during pregnancy. These disorders often involve lifelong intellectual disability. Although many children with FAS or related conditions also have facial abnormalities, in other children the only sign of the disease is cognitive or behavioral impairment. Researchers aren't sure exactly how many children in the United States have FAS or related conditions, but estimates from the Centers for Disease Control and Prevention range from 2 to 15 cases for every 10,000 live births. Although fetal alcohol disorders can be prevented if women do not drink alcohol during pregnancy, treatments are needed to help reverse the effects of alcohol on the fetus and to help children who are born with the condition. To better understand exactly how alcohol can have such devastating effects on the fetus during early development, scientists treated pregnant mice with alcohol and then measured certain substances that show the body's immune response. The researchers found that some, but not all, of the immune system indicators were affected by alcohol. In a second experiment, scientists injected mice with a specific peptide that may reduce the changes in the immune system caused by alcohol, and then injected the mice with alcohol. They suspected that the mice treated first with the peptide would not show changes in the immune system, and that was exactly what happened. These results help scientists understand the effects of alcohol damage and may help them identify and test new interventions. (PMID: 23174390)

Pregnancy Complications

Preterm birth. The NICHD served as the scientific lead for the Surgeon General's Conference on Preventing Preterm Birth in 2008, which developed the national agenda and action plan aimed at preventing preterm birth. This topic is an active research focus for the NICHD. The following current research efforts are supported by the PPB:

Evaluating whether treatments with antenatal steroids between 34 and 36 weeks of pregnancy will decrease infants' need for oxygen support

Studying women who are pregnant for the first time, with the goal of identifying factors in women who may be at risk for complications, including pregnancy-induced hypertension, preterm delivery, and low-birth-weight infants, during their first pregnancy.

NICHD research formed the basis of a recent change to the gestational period within a pregnancy that is recognized as “term” or “full term.” According to the new designations :

Early term is defined as 37 weeks through 38 weeks and 6 days.

Full term is defined as 39 weeks through 40 weeks and 6 days.

Late term is 41 weeks through 41 weeks and 6 days.

Postterm is 42 weeks and beyond.

NICHD research documented poorer health outcomes, including a 20% greater risk of breathing, feeding, and temperature problems, among babies born at 37 and 38 weeks gestation compared to those born at 39 weeks or later. These findings contributed to the designation changes (PMID: 23645117).

Gestational diabetes. The DIPHR Epidemiology Branch is currently studying the increased risk of hypertension in women with gestational diabetes mellitus. In addition, researchers in this Branch recently reported that women with gestational diabetes may be able to prevent the development of type 2 diabetes by following a healthy diet after pregnancy. Read more about this finding.

Preeclampsia. Studies are ongoing to determine whether abnormal levels of certain substances in the blood can predict preeclampsia. NICHD researchers and others have found that women who develop preeclampsia have higher levels of a substance called soluble fms-like tyrosine kinase 1 (sFlt1) and lower levels of placental growth factor and vascular endothelial growth factor than women who do not develop preeclampsia. Read more about preeclampsia research supported by the NICHD.

Infections. Researchers investigating the expression and regulation of a group of innate immune receptors, called Toll-like receptors (TLRs), discovered that TLRs may play a role in infection-associated pregnancy complications by regulating the infection-induced inflammatory responses at the maternal-fetal interface.

Pregnancy loss (miscarriage and stillbirth). Another recent study supported by the PPB found that women experiencing two stressful life events in the year before their delivery were 40% more likely to have a stillbirth than were women who reported no such events.

Labor and Delivery

The Consortium on Safe Labor, within the DIPHR Epidemiology Branch, is evaluating the appropriateness of relying on the Friedman curve, which has traditionally been used to plot hours of labor against cervical dilation in centimeters, to guide decision making. This study is evaluating labor progression to determine the appropriate time to perform a cesarean section in women with protracted labor and/or arrest. Researchers are tracking trends in preterm deliveries, practices such as induced labor, and how environmental and other factors may influence fertility, pregnancy, and pregnancy outcomes over time. Results from this study suggest that labor today may last longer than it did for women 50 years ago.

Studies on the epidemiology of HIV infection and complications in pregnant women and the safety of using new medications during pregnancy

Investigating interventions to identify, prevent, and treat women at risk for obstetric fistula

In 2006, an NIH State-of-the-Science Conference on Cesarean Delivery on Maternal Request, formed in response to the growing trend in requests for cesarean deliveries, assessed the potential benefits and risks of requested cesarean deliveries versus vaginal deliveries. Read the conference statement (PDF - 3.59 MB).

Current studies in the Developmental Biology and Structural Variation Branch of the DER include immunobiology of the placenta and maternal-fetal interactions. The Branch also funds opportunities for and studies on understanding embryonic development and the origin and development of structural birth defects.

Established in 2003 by the PPB, the Stillbirth Collaborative Research Network is currently studying stillbirth cases at five clinical sites around the country and completing a case-control study that is the first large stillbirth study in the United States to simultaneously include population-based controls and complete fetal autopsy and placental pathology examinations.

The PPB created the Maternal-Fetal Medicine Units (MFMU) Network in 1986 to address the issue of preterm birth. The Network includes 14 clinical centers and a data coordinating center. More than 45 clinical trials have been completed or are in progress.

The Birth Defects Research Group is a multicenter, multidisciplinary group led by the NICHD to investigate the etiology of birth defects, particularly NTDs. The group was the first to discover that homocysteine levels were elevated for women carrying fetuses affected by NTDs. This group is supported by the NICHD's DIPHR.

The NICHD supports the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network, in partnership with the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Deafness and Other Communication Disorders, with the aim of studying the effects of prenatal alcohol exposure on the risk of SIDS, stillbirth, and other adverse outcomes.